CA OMFS Update: 2024 'WC' Report Billing Codes
California’s Division of Workers’ Compensation (DWC) announced reimbursement updates to the Physician and Non-Physician Practitioner Services section of the Official Medical Fee Schedule (OMFS), effective for dates of services rendered on or after February 15, 2024.
The DWC order and related documents are on the DWC website’s OMFS page. The updates conform the OMFS to the Centers for Medicare and Medicaid Services (CMS) payment system, as California Labor Code section 5307.1 requires.
Below is a list of the increased rates for California-Specific codes.
California-Specific Codes: Reimbursement Increase
California Code of Regulations Section 9789.12.14 establishes “California Specific Codes,” which begin with the prefix “WC.” Physicians report these codes when submitting reports or furnishing copies of chart notes, x-rays, or scans.
For example, a primary treating physician should bill WC002 when submitting the required PR-2 progress report. The reimbursement owed to the provider reporting the WC002 is $15.19 for dates of service on or after February 15th.
Annually, the DWC establishes new reimbursements for these California-Specific ‘WC’ codes. The table below outlines the new reimbursement rates due and the percent change in the reimbursement rate compared to the current 2023 reimbursement.
California-Specific Billing Code |
Description |
Reimbursement Effective 2/15/2024 |
Additional Page Reimbursement Effective 2/15/2024 |
2024 Reimbursement Change |
WC001 |
Doctor’s First Report of Occupational Illness or Injury (Form 5021) |
Not reimbursable |
N/A (not applicable) |
N/A |
WC002 |
Primary Treating Physician’s Progress Report (Form PR-2) |
$15.19 |
n/a |
4.61% |
WC003 |
Primary Treating Physician’s Permanent & Stationary Report (Form PR-3) |
$47.04 for first page |
$28.92 each additional page. Maximum of six pages absent mutual agreement ($191.64) |
4.60% |
WC004 |
Primary Treating Physician’s Permanent & Stationary Report (Form PR-4) |
$47.04 for first page |
$28.92 each additional page. Maximum of seven pages absent mutual agreement ($220.56) |
4.60% |
WC005 |
Psychiatric Report requested by the WCAB or the Administrative Director, other than medical-legal report |
$47.04 for first page |
$28.92 each additional page. Maximum of six pages absent mutual agreement ($191.64) |
4.60% |
WC007 |
Consultation Reports requested by the WCAB or the Administrative Director |
$47.04 for first page |
$28.92 each additional page. Maximum of six pages absent mutual agreement ($191.64) |
4.60% |
WC008 |
Chart Notes |
$13.59 for up to the first 15 pages |
$0.28 for each additional page after the first 15 pages |
4.62% |
WC009 |
Duplicate Reports |
$13.59 for up to the first 15 pages |
$0.28 for each additional page after the first 15 pages |
4.62% |
WC010 |
Duplication of X-Ray |
$6.23 per x-ray |
N/A |
4.53% |
WC011 |
Duplication of Scan |
$13.59 per scan |
N/A |
4.62% |
WC012 |
Missed Appointments. This code is designated for communication only. It does not imply that compensation is owed. Non-reimbursable absent agreement. |
No Fee Prescribed/Non Reimbursable absent agreement |
N/A |
N/A |
Stay tuned — we’ll report on additional changes to the Physician Fee Schedule in this space.
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